From Fitness Tests to PE: What Every Parent, Educator, and Coach Needs to Know About Eating Disorders

Now that a new school year is officially in full swing, parents may have prepared themselves for conversations around food, body image, and weight that could potentially have a negative effect on their child in the classroom or on campus. But one topic that is often overlooked for young students is exercise. While movement and sport can play important roles in a student’s identity and wellbeing, the reality remains that traditional assessments of fitness and wellness can be incredibly outdated and harmful to someone in recovery or at risk for developing an eating disorder.

“Moving our bodies is wonderful for a myriad of reasons — however society’s recommendations for exercise are usually based in minutes daily and a fear-based approach that stigmatizes larger body sizes,” says Equip registered dietitian Erin Reeves. “It’s important to focus on helping kids find movement they like — especially through non-traditional sports — to help them find ways they can move that go beyond weight, calorie burn, and ‘health’ as reasons for moving,such as improved mood and better concentration for school work.”

The problem is that many academic institutions haven’t caught up to a modern approach to movement and are still measuring physical “success” by outdated, standardized tests, often souring young people’s relationship with exercise. Until 2013, many students had to participate in the "Presidential Fitness Test" which was designed to "capture best performance at core strength, aerobic capacity, upper-body strength, speed and agility, and flexibility." Now, many kids have to take the The FitnessGram PACER Test, "a multistage aerobic capacity test that progressively gets more difficult as it continues.” Additionally, many coaches may not have up-to-date or accurate information on eating disorders and lack the education and training to recognize the signs of problematic behavior.

“Physical education in the U.S. has traditionally placed too much emphasis on factors that are largely out of the student’s control, like body mass index (BMI),” says Equip’s VP of Medical Affairs, Katherine Hill, MD. “Many PE teachers and coaches are surprised to learn that BMI doesn’t correlate very well with physical fitness or athletic performance. In addition to being a poor correlate of health and fitness, measuring BMI in a public setting like school can be traumatic and triggering. Some schools publically weigh children and compute their BMI in front of their classmates. Height and weight measurements should be considered sensitive health information, and should be reserved for private settings like medical visits with a pediatrician.”

Whether you’re a parent, coach, or faculty member who wants to know how you can encourage and cultivate a supportive, non-judgmental environment for students in relation to movement, here’s what you need to know.

The warning signs of an Eating Disorder every parent, P.E. teacher, and coach should be aware of

While many people are familiar with the common food-based symptoms of eating disorders , few are as well-versed in the signs of a problematic relationship with exercise. Equip therapist Kelsey Hoeper, LPC, NCC, CT, who was an athlete for most of her life, says that while her experience around movement was largely positive, in hindsight, she can see how many of the messages she absorbed may have played a part in the development of disordered eating.

“A lot of us are familiar with those go-to motivational statements coaches often preach to their athletes like ‘food is fuel,’” she says. “That mantra, and ones similar to it, can imply that food is only meant to help us achieve those athletic goals, instead of viewing food items as something for the sake of enjoyment and nothing more. When so much emphasis is put on nutrition, macros and micros, athletes may interpret that as them needing to 100 percent control their bodies, and if they can’t, then they can’t trust their bodies.”

Given the normalization and prevalence of these messages, the warning signs of problematic or excessive exercise can be tough to spot, because they can resemble the actions of a “dedicated” athlete. But according to Hoeper, there are some telltale signs of a serious issue that parents, teachers, and coaches should know:

  • Body checking (constantly adjusting sports clothing, swimsuits, etc.)
  • Eating only foods they deem “healthy” (e.g. salads, protein bars and shakes)
  • Frequently throwing unfinished food away
  • Not eating with the team during team dinners/trips
  • Skipping social events with team members
  • Excessive exercise (e.g. running an extra mile after practice ends)

“Compulsive exercise is a common warning sign of an eating disorder,” Hill says. “If a student is exercising multiple hours a day, never taking a day off even when they’re sick, tired, or injured, or performing ‘extra’ workouts in addition to team workouts, these might be red flags for an eating disorder..”

What you need to know about school fitness tests

While standardized fitness tests have changed over the years, the notion of “testing” fitness in a one-size-fits-all way doesn’t sit right with many experts and individuals who have lived through the realities of an eating disorder.

“Interestingly enough, discussion of the PACER Test recently came up in conversation between my college-age daughter and her best friend,” says Equip family mentor Kristi Humston. “While the intentions of those who developed this test may (or may not) have been well-intended and my daughter and her friend are now able to laugh about their shared experiences of anxiety and ‘cramming’ to do well, the sad reality is that one walked away believing she was an athlete and the other feeling humiliated in front of her peers. Neither was an accurate measure of true fitness nor was it an indication of the incredible young women both continue to become today.”

Hill says that overall, standardized testing for physical fitness in schools can be harmful in many ways, from triggering eating disorders to creating a lifelong aversion to exercise. “And often, a student’s grade can be negatively affected if they are not naturally athletic,” she says. “Basing a student’s grade on standardized fitness tests or how fast they can run a mile can be humiliating for some and create fear around exercise. Student’s grades should instead be based upon factors like work ethic, having a great attitude, and being a team player.”

Because individuals with eating disorders can often be very achievement-focused, Reeves agrees that testing can be extremely activating for an eating disorder and should be explored with caution. Luckily, there are ways to opt out of these scenarios. If parents feel that the mandatory tests may be detrimental to their loved one, they have the right to discuss the possibility of having their child excused. “Your health care provider can ensure you have the proper documentation to receive accommodations for your child. Understanding the curriculum and requirements can be extremely helpful in helping your child feel included without being triggered,” Reeve says.

Is P.E. class okay for someone with an eating disorder?

According to experts, movement and exercise is not always off the table for those in recovery from or at risk for an eating disorder (as long as they are medically stable and approved by their physician to participate). “When done properly, PE can be a therapeutic way to reintroduce activity in a supervised environment,” Hill says. “For some patients with eating disorders, getting back to PE can be motivating and help encourage meal completion. For these students, I recommend a gradual return to full activity.”

Hill says the ideal PE course helps students learn that movement — when performed in a sustainable way and for the right reasons — can be immensely beneficial for physical and mental health. “And that there are so many different ways to learn how to move your body — there is truly something for everyone when it comes to physical activity,” she says. “Exercise can and should boost self-esteem, lift mood, improve sleep quality, and relieve stress. But unfortunately, for many, PE does not achieve this mission.”

For those with active eating disorder symptoms, participating in PE or other activity-based extracurriculars can potentially do more harm than good. “If the PE course requires weights to be taken or discusses topics like dieting, ob*sity, or weight loss, students or their families should speak to their medical provider to get a medical exemption from the course,” Hill says.

Hill also adds that the goal of physical education should not be to shame kids who perform “poorly” on fitness tests or have BMIs in the “red zone” (something largely based on genetics and external factors outside the student’s control anyway). The mission instead should be to instill a lifelong enjoyment of physical activity and movement for all students, not just athletes.

What can families do to minimize the potential risks of harmful messages around exercise?

Given the prevalence of fitness tests and traditional methods of physical education in schools, what can parents do to ensure their child isn’t exposed to toxic diet culture rhetoric or harmful messages around exercise? Reeves says initiating a conversation with school faculty can be an important starting point for ensuring the academic environment is as safe and supportive for their child as possible when it comes to eating disorder recovery or prevention.

“Talk to your school, coaches, and PE teachers,” Reeves says. “Get a feel for their outlook and bias towards movement, weight, and nutrition. Their personal views will largely shape how the programs are run.”

Hill also encourages parents of kids with eating disorders to help educate PE teachers and coaches on activities or messages that might be triggering. “Chances are your child is not the first nor last kid with an ED that will be in that class, and chances are also good that your child’s PE teacher has not received a reputable education on eating disorders either,” she says.

Michelle Konstantinovsky
Equip Contributing Editor
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